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City of Orono ai�3 �� <br /> �g <br /> Building Permit Application <br /> for New Structures or Additions ����ssl�� s��r- �`�y 's <br /> Mailing Address: ��>/Z —��� , <br /> Permit number. C(�'(��_ <br /> O�,D,�.O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: �7 � /� <br /> ,.;__ ReceivEd by: /��J �� <br /> a, ,"' �, Street Address:' � � ,/ <br /> '$`,�, Gtiti 2750 Kelley Parkway ��"7 �C Plan review fee: `� � 7� ' S� <br /> '�9 gw Orono, MN 55356 / <br /> kEsxo - . _..�_�.._..._---.. - __--- <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www ci orono mn us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMAT O ) <br /> Job Site Address: ��� ������{— (���� <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events wil!not be allowed. <br /> CONTRACTOR/ PLICANT INFO ATION: / <br /> Name: � �c ��:� ' L--�—� <br /> :�*ate License# Expiration Date: <br /> Phone: office ell <br /> Mailing Address: Cit : ( �-�.�� ZIP: � <br /> L�ntact Person: a, �.. Applicant is: Contr ctor / Homeowner (Circle One) <br /> Email and/or Fax: < < x - � 2 �,c�� <br /> c <br /> PROPERTY OWNER INFORMATION• <br /> ►vame: Tt.���� �S <br /> Phone (day): �j������O - S�(� <br /> Address: a-�� S�y,,t�,,,� �� City: (.��'�-�,� ZIP: �_3� <br /> Email and/or Fax � <br /> ARCHITECT/ENGIN� E�ER I�NFORMATION: <br /> Name: ��,.�,.�� ��s� �t+�,� <br /> Phone (day): �- -� ' - <br /> Address: j tc�c�� ►-�„m��.�„� S - City:{'��w���� ZIP: SS�-(�� <br /> Email and/or Fax: '�5�--.��'�S-_,��v <br /> PROJECT INFORMATION: <br /> 1. Type of Project 2. Proposed Use 3. Structure Type 4.Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑ Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑ Deck <br /> ❑ Relocation � � ) detached garage ❑ Office/Commercial ❑ Private Sewer <br /> �ther. (specify)�� �'`-'�(.�- ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> **Any earth movement may require ❑ Commercial ther(specify) <br /> MCWD review 8� permits. ❑ Industrial ��i.(�� ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ �� �c9� <br /> Packet Last Updated: 03-06-2012 <br /> -21 - <br />